Chest
Volume 111, Issue 4, April 1997, Pages 1077-1088
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The Components of a Respiratory Rehabilitation Program: A Systematic Overview

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Objective

To determine the contribution of the various components of a rehabilitation program to the improvement of exercise capacity and health-related quality of life (HRQL) in patients with COPD.

Data sources

MEDLINE (1966 to April 1996) was searched. Abstracts presented at international conferences were also hand searched for additional relevant trials. Bibliographies of the retrieved articles were reviewed. Experts in rehabilitation were consulted to uncover unpublished trials.

Study selection

Randomized controlled trials (RCTs) of exercise training, breathing exercises, education, and psychosocial support in patients with COPD were primarily included if (1) the treatment effect of a specific component of a rehabilitation program could be isolated, and (2) exercise capacity, HRQL, compliance with medical therapy, and/or knowledge about the disease were measured.

Data synthesis

A best-evidence synthesis was conducted; 22 RCTs contributed to the analysis. We found the following: (1) the patients exposed to interventions that included exercise training improved their functional exercise capacity and HRQL; (2) exercise training was muscle specific; (3) the evidence to support inspiratory muscle training and other breathing exercises as an adjunct to exercise training in COPD remains equivocal; (4) the contribution of education has not been well addressed; and (5) psychosocial support reduced dyspnea acutely and, when used as an adjunct to rehabilitation, promoted compliance with an exercise regimen and improved HRQL.

Conclusion

Respiratory rehabilitation is likely to improve functional exercise capacity and HRQL if it includes exercise training and psychosocial support. Further research is required to better define the types and intensity of exercise as well as the influence of respiratory muscle training and patient education.

Section snippets

Materials and Methods

In conducting the systematic overview, we used the approach of “best-evidence synthesis” proposed by Slavin.10 This approach considers that the best evidence comes from studies that have a high internal and external validity and that use well-specified and defined a priori inclusion criteria. Furthermore, it refers to the magnitude of the treatment effect as an adjunct to a full discussion of the literature at hand.

Literature Search

Two hundred eighty-eight publications were retrieved from the computerized search; 12 met the inclusion criteria of the best-evidence synthesis. The level of agreement between the reviewers was excellent (Kappa=0.84 [95% confidence interval, 0.72 to 0.96]). Fifty-four abstracts were also identified, none of which contributed to the review. The reasons for excluding 276 studies were as follows: wrong population (mostly asthmatics [n = 167]); intervention not meeting the definition of

Discussion

Although respiratory rehabilitation has been shown to be beneficial in improving HRQL and exercise capacity,6 the contribution of the components of rehabilitation programs has been less well defined. Clearly, a better understanding of the components will have important implications for resource allocation as respiratory rehabilitation becomes more widespread.

The varied outcome measures used within a particular intervention did not allow us to estimate satisfactorily the real treatment effect of

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